POS0131 CONCORDANCE BETWEEN LOCATION OF SELF-REPORTED SITE OF MUSCULOSKELETAL PAIN IN PSORIASIS AND FINDINGS OF INFLAMMATION BY ULTRASOUND
Authors: S. Kamp Felbo, L. Terslev, I. J. Sørensen, O. Hendricks, D. Kuettel, R. Lederballe Pedersen, S. Chrysidis, M. Østergaard
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with psoriasis (PsO) often report muskuloskeletal (MSK) pain without clinical findings of inflammation. Ultrasound (US) is more sensitive than clinical evaluation in detecting synovitis and enthesitis, and we have previously found that patients with PsO and pain more often have US signs of inflammation in joints and entheses than patients without pain (1), indicating possible psoriatic arthritis (PsA). Whether the area of reported pain in these patients correspond to inflammation by US has not yet been investigated. Objectives In patients with PsO with self-reported MSK pain, to investigate if the area of reported of pain corresponds to synovitis and/or enthesitis. Methods PsO patients with self-reported MSK pain (n=79, Table 1), recruited from a Danish nationwide survey, were evaluated in one of four rheumatology departments with greyscale (GS) and color Doppler (CD) US of 48 joints and 12 entheses, applying the OMERACT scoring systems (2) for US synovitis (defined as GS score ≥2 or CD≥1) and enthesitis (defined as ≥1 GS inflammatory finding (hypoechogenicity/thickening) and CD score ≥1). Patients indicated the location of current pain in 21 areas on a homunculus, out of which shoulder (joint), elbow (joint and common extensor enthesis), hand (wrist and MCP, PIP, and DIP-joints 1-5), knees (joint and quadriceps- and patellar entheses), feet (ankle and MTP-joints 1-5) and heel (Achilles- and plantar fascia entheses) were evaluated by US, se Figure 1. Association between self-reported pain and US inflammation (synovitis/enthesitis) was explored using Fisher’s exact test and odds ratios (OR) for 2x2 tables. Agreement was calculated using Cohen’s kappa (κ). Table 1. Population characteristics (n=79) Sex (female ) 33 (42) Age (years ) 57 (47-66) Body Mass Index (kg/m 2 ) 28.4 (24.8-34.8) Disease duration PsO (years ) 25 (11-39) Swollen joint count (0-66 ) 0 (0-1) Tender joint count (0-68 ) 2 (0-5) Tender enthesis count (0-16 ) 1 (0-2) Fibromyalgia tender point count (0-18 ) 1 (0-5) Psoriasis Area and Severity Index (0-72 ) 1.5 (0.2-4.2) Nail psoriasis (presence ) 26 (33) Physician VAS (0-100 ) 3 (1-6) CRP (mmol/l ) 2.1 (0.5-4.1) Global VAS (0-100 ) 16 (4-45) Pain VAS (0-100 ) 20 (5-39) Health Assessment Questionnaire (0-3 ) 0.25 (0.00-0.69) DAS28-CRP (0-10 ) 1.6 (1.5-2.6) Disease Activity in Psoriatic Arthritis (0-164 ) 5.2 (4.1-20.7) Numbers are median (IQR) or no. (%). CRP: C-reactive protein, DAS28: Disease Activity Score - 28 joints, VAS: Visual Analog Scale Figure 1. Self-reported pain versus ultrasound (US) inflammation in different areas, and in all areas considered together, presented as 2x2 tables and corresponding odds ratios (OR, p-value) (Fisher’s exact test), and agreement (Cohens Kappa (κ (95% confidence interval)). Results Of the areas examined by US, pain was most frequent in the knees (41% of patients), while US inflammation was most frequent in the hand/wrist (55%). In total, US inflammation was found in of 72% patients (synovitis in 71%, enthesitis in 17%). In 47% of patients, US inflammation was found in one or more of the painful sites. Figure 1 shows 2x2 tables of pain versus US inflammation in different areas and corresponding ORs and κ-values. Self-reported pain was significantly related to US inflammation in that area, both overall (OR=3.1, p&gt;0.001) and for the specific areas of the left hand (OR 3.1, p=0.03) and right elbow (OR 18.3, p=0.01). Agreement between self-reported pain and US inflammation, as measured by κ, was overall low, κ =0.18(95% confidence interval 0.10-0.27), with highest agreement found for the right elbow (κ = 0.30(-0.9-0.68)). Pain only in areas not examined by US (back/hips/breastbone/jaw) was indicated by 16% of patients. Conclusion While US signs of synovitis and enthesitis is frequent in patients with PsO and pain, concordance between US inflammation and the specific location of pain is only seen in half of the patients. References [1]Felbo SK et al., Rheumatology (Oxford), 2021. [2]Bruyn GA et al., The Journal of Rheumatology, 2019 Acknowledgements The authors would like to thank all participating patients, physicians, laboratory staff, study nurses and secretaries who contributed to this study, Amgen/Celgene for financial study support and The Danish Rheumatism Association and The Danish Psoriasis Research Foundation for support of the work of SKF. Disclosure of Interests Sara Kamp Felbo Grant/research support from: Amgen/Celgene, Lene Terslev Speakers bureau: AbbVie, Janssen, Roche, Novartis, Pfizer, MSD, BMS and GE, Inge Juul Sørensen: None declared, Oliver Hendricks Speakers bureau: Abbvie, Pfizer and Novartis, Dorota Kuettel: None declared, Rasmus Lederballe Pedersen: None declared, stavros chrysidis: None declared, Mikkel Østergaard Speakers bureau: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: AbbVie, BMS, Celgene, Novartis